Zoon's balanitis

Zoon's Balanitis is a chronic condition affecting the glans penis, characterized by a benign inflammatory process. First described by Zoon in 1952, it is also known as plasma cell balanitis due to the predominance of plasma cells in histological samples. The condition predominantly affects uncircumcised, middle-aged to elderly men, although rare cases have been reported in circumcised individuals and females (termed Zoon's vulvitis in such cases).

Etiology and Pathogenesis

The exact cause of Zoon's Balanitis remains unclear, but it is thought to be related to poor hygiene, chronic irritation, and an inadequate foreskin retraction. The presence of a moist environment under the foreskin may facilitate the proliferation of bacteria and fungi, leading to chronic inflammation. Immunological factors and the role of human papillomavirus (HPV) have been investigated, but no definitive causal relationship has been established.

Clinical Features

Patients with Zoon's Balanitis typically present with a well-demarcated, shiny, erythematous plaque on the glans penis. The lesion is usually asymptomatic but can be associated with mild itching or discomfort. Unlike other forms of balanitis, Zoon's does not produce a purulent discharge. The chronic nature of the condition means that symptoms can persist for years if left untreated.

Diagnosis

Diagnosis of Zoon's Balanitis is primarily clinical, based on the characteristic appearance of the lesion. Dermoscopy can aid in the diagnosis, revealing a pattern of dotted vessels on a reddish-brown background. Biopsy is the definitive diagnostic tool, showing a dense infiltrate of plasma cells in the dermis, epidermal atrophy, and absence of significant spongiosis. Special stains may be used to rule out infectious causes.

Treatment

The management of Zoon's Balanitis involves addressing the underlying inflammation and minimizing chronic irritation. Treatment options include:

• Improved hygiene and the use of mild cleansers.
• Topical corticosteroids, which can reduce inflammation and symptoms.
• Circumcision, which is curative in most cases by removing the affected tissue and eliminating the moist subpreputial space.
• Other treatments, such as photodynamic therapy, carbon dioxide laser ablation, and topical calcineurin inhibitors, have been reported with varying degrees of success.

Prognosis

With appropriate treatment, the prognosis for Zoon's Balanitis is generally good. Circumcision offers a definitive cure, while conservative measures can control symptoms in many patients. However, the condition can recur, especially if predisposing factors are not addressed.

Epidemiology

Zoon's Balanitis is relatively rare, with the exact incidence unknown. It primarily affects uncircumcised middle-aged to elderly men but can occur at any age and in circumcised individuals.

See Also

• Balanitis
• Circumcision
• Dermoscopy
• Human papillomavirus